1
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Yoon JH, Jin M, Kim M, Hong AR, Kim HK, Kim BH, Kim WB, Shong YK, Jeon MJ, Kang HC. Clinical Characteristics and Prognosis of Coexisting Thyroid Cancer in Patients with Graves' Disease: A Retrospective Multicenter Study. Endocrinol Metab (Seoul) 2021; 36:1268-1276. [PMID: 34823306 PMCID: PMC8743582 DOI: 10.3803/enm.2021.1227] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The association between Graves' disease (GD) and co-existing thyroid cancer is still controversial and most of the previously reported data have been based on surgically treated GD patients. This study investigated the clinicopathological findings and prognosis of concomitant thyroid cancer in GD patients in the era of widespread application of ultrasonography. METHODS Data of GD patients who underwent thyroidectomy for thyroid cancer between 2010 and 2019 in three tertiary hospitals in South Korea (Asan Medical Center, Chonnam National University Hwasun Hospital, and Pusan National University Hospital) were collected and analyzed retrospectively. In the subgroup analysis, aggressiveness and clinical outcomes of thyroid cancer were compared nodular GD and non-nodular GD groups according to the presence or absence of the thyroid nodules other than thyroid cancer (index nodules). RESULTS Of the 15,159 GD patients treated at the hospitals during the study period, 262 (1.7%) underwent thyroidectomy for coexisting thyroid cancer. Eleven patients (4.2%) were diagnosed with occult thyroid cancer and 182 patients (69.5%) had microcarcinomas. No differences in thyroid cancer aggressiveness, ultrasonographic findings, or prognosis were observed between the nodular GD and non-nodular GD groups except the cancer subtype. In the multivariate analysis, only lymph node (LN) metastasis was an independent prognostic factor for recurrent/persistent disease of thyroid cancer arising in GD (P=0.020). CONCLUSION The prevalence of concomitant thyroid cancer in GD patients was considerably lower than in previous reports. The clinical outcomes of thyroid cancer in GD patients were also excellent but, more cautious follow-up is necessary for patients with LN metastasis in the same way as for thyroid cancer in non-GD patients.
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Affiliation(s)
- Jee Hee Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju,
Korea
| | - Meihua Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan,
Korea
| | - A Ram Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju,
Korea
| | - Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju,
Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan,
Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Ho-Cheol Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju,
Korea
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2
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Osorio C, Ballestas J, Barrios D, Arévalo A, Montaño S, Pérez N, Guardo Y, Oviedo H, Zambrano V, Redondo K, Herrera F. Clinical characteristics associated with the finding of thyroid cancer originating from hot nodules in patients with hyperthyroidism: a case report and systematic review of the literature. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in patients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule.
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3
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Al-Sharafi BA, AlSanabani JA, Alboany IM, Shamsher AM. Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic. Thyroid Res 2020; 13:8. [PMID: 32518593 PMCID: PMC7275581 DOI: 10.1186/s13044-020-00082-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background The prevalence of thyroid cancer is increasing worldwide. No previous data are available on the prevalence of thyroid cancer in Yemen. We performed this study to determine the prevalence of thyroid cancer among patients with thyroid nodules in Yemen. Methods A retrospective chart review was performed for 550 patients with thyroid nodules who underwent fine needle aspiration and/or thyroid surgery at a private endocrine clinic and at an endocrine clinic in a tertiary hospital in Yemen over a 3 -year period from October 2016–2019. The prevalence of thyroid cancer; the sonographic findings, Bethesda classification, age, sex, thyroid stimulating hormone (TSH) levels of the patients; and the nodule size and number were reviewed. Results A total of 550 charts were reviewed [501 females (91.1%) and 49 males (8.9%)]. The thyroid cancer prevalence among the patients was 13.8% (CI = 10.9–16.7), and the mean age of the patients was 38.5 years (SD = 12.2). The TSH level and the rate of cancer were significantly related (P = 0.01), but no significant difference in the prevalence of thyroid cancer was found between females (13.4%) and males (18.4%) (P = 0.334). When correlating the rate of cancer with the ultrasound guided fine needle aspiration (UG-FNA) result, those with Bethesda system category III and IV, V and VI had malignancy rates of 20.8, 27.2, 52.4 and 69.2%, respectively. Thyroid nodules highly suspicious for malignancy on ultrasound had a 70% cancer diagnosis rate. The most common thyroid cancer was papillary cancer (71%), followed by follicular cancer (23.7%). Among those undergoing surgery, 44.2% had thyroid cancer, and 5.2% had a premalignant diagnosis. Conclusion Thyroid cancer has a higher prevalence in Yemen than in other middle eastern countries. Our study also reports a higher rate of follicular thyroid cancer than that in other published data, which has to be confirmed by further studies. The malignancy and premalignant diagnosis rate was ~ 50% in our patients who underwent surgery. Many centers in Yemen still do not perform FNA before thyroid surgery. It is important that other centers in the country start emphasizing the need for FNA before surgery. This will decrease the number of unnecessary surgeries and associated complications.
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Affiliation(s)
| | | | - Ibraheem M Alboany
- Department of Radiology, University of Science and Technology, Sana'a, Yemen
| | - Amani M Shamsher
- Department of Pathology, University of Science and Technology Hospital, Sana'a, Yemen
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4
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Zhang J, Yan D, He L, Zhang Q, Wen S, Liu P, Zhou H, Peng Y. Expression of Caveolin-1 Is Associated With Thyroid Function in Patients With Human Papillary Thyroid Carcinoma. Dose Response 2020; 18:1559325820919330. [PMID: 32313526 PMCID: PMC7160781 DOI: 10.1177/1559325820919330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this study was to evaluate the levels of caveolin-1 in thyroid
follicular epithelial cells of papillary thyroid cancer, follicular thyroid
cancer, and nonmalignant thyroid nodule benign follicular adenoma, as well
as to explore the relationship between the levels of caveolin-1 and thyroid
function. Methods: Thirty cases of papillary thyroid cancer, 10 cases of follicular thyroid
cancer, 32 cases of nonmalignant thyroid nodule benign follicular adenoma,
and 30 controls were enrolled in this study. Caveolin-1 expression in tissue
specimens obtained from these cases was evaluated by immunohistochemistry
and Western blotting. Results: Caveolin-1 expression in thyroid epithelial cells of patients with papillary
thyroid cancer, particularly female patients, was significantly higher than
that in patients with follicular thyroid cancer and nonmalignant thyroid
nodule benign follicular adenoma (P < .005). Serum
thyroid-stimulating hormone (TSH) levels in the caveolin-1-positive
expression group were lower than that in the caveolin-1-negative expression
group, and the lowest expression of caveolin-1 was detected in tissues of
patients with Graves’ disease. The serum TSH level was associated with
caveolin-1 expression in thyroid epithelial cells. Conclusion: Caveolin-1 may participate in regulating thyroid function and is a potential
biomarker of follicular thyroid cancer.
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Affiliation(s)
- Jingyi Zhang
- Department of Endocrinology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Immunology, Nanjing Medical University, Nanjing, China.,The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Dongxia Yan
- Department of Pathology, Ma'anshan People's Hospital, Ma'anshan, China
| | - Lianping He
- College of Experience Industry, Anhui Polytechnic University, Wuhu, Anhui, China
| | - Qing Zhang
- Department of Pathology, Ma'anshan People's Hospital, Ma'anshan, China
| | - Shuang Wen
- Department of Immunology, Nanjing Medical University, Nanjing, China
| | - Peiyu Liu
- Department of Pharmacology, School of Basic Medical Science, Nanjing Medical University, Nanjing, China
| | - Hong Zhou
- Department of Immunology, Nanjing Medical University, Nanjing, China
| | - Yongde Peng
- Department of Endocrinology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
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5
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Varadharajan K, Choudhury N. A systematic review of the incidence of thyroid carcinoma in patients undergoing thyroidectomy for thyrotoxicosis. Clin Otolaryngol 2020; 45:538-544. [PMID: 32149464 DOI: 10.1111/coa.13527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/01/2020] [Accepted: 02/29/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Hyperthyroidism (HT) has been associated with no insignificant rates of thyroid malignancy. There are no current specific guidelines that suggest routine preoperative imaging for thyroid nodules in patients with Grave's disease. We therefore performed a systematic review assessing rates of thyroid malignancy in patients undergoing surgery for different causes of HT: Grave's disease (GD), toxic adenoma (TA) and toxic multinodular goitre (TMNG). METHODS Major databases (MEDLINE, PubMed and the Cochrane library) were searched to identify eligible studies. RESULTS After searching and appraising, 33 papers were found to be eligible for analysis. The mean overall rate of malignancy was 8.5% (range 0.8%-32.4%). The mean rates based on histological subtype were as follows: papillary thyroid cancer (PTC), 3.1% (range 0%-13.2%); micropapillary carcinoma (mPTC), 5.1% (range 0%-16.9%); and follicular thyroid cancer (FTC), 0.8% (range 0%-4.4%). In those patients who had preoperative imaging, mean malignancy rates were higher in patients with pre-identified nodules (19.8%) compared to those without any nodules (8.7%). Mean rates were lower in patients with GD/diffuse goitre (5.9%) compared to patients with TA (6.5%) and TMNG (12%). CONCLUSION Hyperthyroidism is associated with notable rates of thyroid cancer, although the mechanisms for this are not clear. The presence of nodules increases this risk. This review raises the question for considering preoperative assessment of nodules in all patients undergoing surgery for HT, in order to correctly assess and evaluate any patients with suspected concurrent thyroid malignancy, before proceeding with surgery.
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6
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Keskin C, Sahin M, Hasanov R, Aydogan BI, Demir O, Emral R, Gullu S, Erdogan MF, Gedik V, Uysal AR, Baskal N, Corapcioglu D. Frequency of thyroid nodules and thyroid cancer in thyroidectomized patients with Graves' disease. Arch Med Sci 2020; 16:302-307. [PMID: 32190140 PMCID: PMC7069426 DOI: 10.5114/aoms.2018.81136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Incidental thyroid cancers are frequently detected in patients operated on for Graves' disease (GD). There are no clear data about the incidence and risk factors of incidental thyroid cancer in operated GD patients. The aim of this study is to evaluate the risk of thyroid carcinoma in surgically treated GD patients. MATERIAL AND METHODS The data of 121 GD patients who underwent total thyroidectomy in a single center between 2005 and 2015 were retrospectively evaluated. The diagnosis of thyroid cancer was based on pathological examination. RESULTS Thyroid cancer was demonstrated in postoperative pathology specimens of 34 patients who were surgically treated for GD (28.1%). Preoperative thyroid ultrasonography (USG) revealed a nodular goiter in 62 (51.2%) patients. Nodules were not detected in the other 59 (48.8%) patients with GD. The frequency of thyroid cancer was significantly higher in patients with nodules (38% vs. 16%; p = 0.009). Thirty-two of the 34 cancer cases had papillary thyroid cancer (PTC), and the remaining 2 had follicular thyroid cancer (FTC). Of the 32 PTC patients, 28 were classical type, 2 patients had the follicular variant, 1 was the oncocytic variant, and 1 was a tall cell variant. CONCLUSIONS The incidence of thyroid cancer was higher in patients who underwent surgery for GD. In addition to a careful physical examination in the follow-up of the patients with GD, ultrasonographic evaluation should be performed. Surgical treatment should not be delayed in patients with GD when indicated.
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Affiliation(s)
- Caglar Keskin
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Mustafa Sahin
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Rovshan Hasanov
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Berna Imge Aydogan
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Ozgur Demir
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Rıfat Emral
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Sevim Gullu
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Murat Faik Erdogan
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Vedia Gedik
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Ali Riza Uysal
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Nilgun Baskal
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
| | - Demet Corapcioglu
- Department of Endocrinology and Metabolic Disease, School of Medicine, Ankara University, Ankara, Turkey
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7
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Bilginer MC, Ozdemir D, Seyrek FNC, Yildirim N, Yazgan AK, Kilic M, Ersoy R, Cakir B. Evaluation of ultrasonographical and cytological features of thyroid nodules in patients treated with radioactive iodine for hyperthyroidism. Diagn Cytopathol 2019; 48:3-9. [PMID: 31674156 DOI: 10.1002/dc.24319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND In this study, we aimed to evaluate ultrasonographical and cytological features of thyroid nodules in patients who were treated with radioactive iodine (RAI) for hyperthyroidism years ago. METHODS Patients who had a history of RAI treatment for hyperthyroidism and had thyroid nodules that were evaluated with fine-needle aspiration biopsy (FNAB) were included in the study. RESULTS There were 27 patients (22 female and 5 male) with a mean age of 59.3 ± 13.5. The indication for RAI treatment was Graves in 5 (18.6%), toxic nodular or multinodular goiter in 16 (69.2%), and unknown in 6 (22.2%) patients. A total of 48 thyroid nodules were evaluated with FNAB and cytological diagnosis were benign in 24 (50.0%), nondiagnostic in 15 (31.2%), atypia of undetermined significance in 5 (10.4%), suspicous for malignancy in 2 (4.2%), and malignant in 2 (4.2%) nodules. Thyroidectomy was performed in 10 patients, 5 were benign (50.0%), and 5 (50.0%) were malignant histopathologically. Ultrasonography features of 31 cytologically/histopathologically benign and five cytologically/histopathologically malignant nodules were compared. Prevalence of isoechoic nodules was higher in benign nodules (P = .025). Macrocalcification was observed in 4 (80.0%) of malignant and 10 (32.3%) of benign nodules (P = .042). CONCLUSION In patients with a history of RAI treatment for hyperthyroidism, thyroid nodules with suspicious ultrasonography features, particulary hypoechoic appearence and macrocalcification, should be evaluated with FNAB irrespective of the time elapsed after RAI treatment.
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Affiliation(s)
- Muhammet C Bilginer
- Department of Endocrinology and Metabolism, SBU Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Fatma N C Seyrek
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Nilufer Yildirim
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Aylin K Yazgan
- Department of Pathology Ankara, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Kilic
- Department of General Surgery, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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Papanastasiou A, Sapalidis K, Goulis DG, Michalopoulos N, Mareti E, Mantalovas S, Kesisoglou I. Thyroid nodules as a risk factor for thyroid cancer in patients with Graves' disease: A systematic review and meta-analysis of observational studies in surgically treated patients. Clin Endocrinol (Oxf) 2019; 91:571-577. [PMID: 31369161 DOI: 10.1111/cen.14069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Graves' disease (GD) is an autoimmune thyroid disorder characterized by hyperthyroidism. The incidence of thyroid cancer in patients with GD varies from 0.15% to 15%. There is conflicting evidence on the role of thyroid nodules as a risk factor for thyroid cancer in patients with GD. DESIGN Three electronic databases (PubMed, Cochrane Library, Scopus) as well as grey literature sources were searched, from inception until 25 February 2019, for observational studies about the prevalence of thyroid cancer in patients with GD. PATIENTS Clinical and ultrasonographic examination was necessary preoperatively for all patients to be classified depending on the presence/absence of thyroid nodules. MEASUREMENTS Primary outcome was the incidence of thyroid cancer. The latter was determined after total or near-total thyroidectomy by the histopathologic report. Statistical analysis was performed with revman 5.3 software. RESULTS The systematic review and meta-analysis included 7 studies with 2582 patients overall. The prevalence of any thyroid cancer was 11.5%. The presence of at least one thyroid nodule in patients with GD was associated with higher risk for thyroid cancer (odds ratio [OR] 5.3, 95% confidence interval [CI] 2.4-11.6, I2 83%). A subgroup analysis showed no difference in thyroid cancer risk in patients with GD according to the number of nodules (solitary versus multiple) (OR 1.4, 95% CI 0.9-2.3, I2 0%). CONCLUSIONS The presence of thyroid nodules is positively associated with the prevalence of thyroid cancer in surgically treated patients with GD. However, further prospective research is needed as the heterogeneity among the studies is high.
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Affiliation(s)
- Anastasios Papanastasiou
- 3rd Department of Surgery, "AHEPA" University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Michalopoulos
- 3rd Department of Surgery, "AHEPA" University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Mareti
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Mantalovas
- 3rd Department of Surgery, "AHEPA" University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Department of Surgery, "AHEPA" University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Gram SB, Rasmussen JH, Feldt-Rasmussen U, Bentzen J, Lelkaitis G, von Buchwald C, Hahn CH. Risk of Thyroid Cancer in 1,504 Patients Referred for Thyroid Surgery with Assumed Benign Histology. Eur Thyroid J 2019; 8:246-255. [PMID: 31768335 PMCID: PMC6873058 DOI: 10.1159/000500539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/16/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aims of this study were to report the risk of thyroid malignancy in cases of either benign fine-needle aspiration (FNA) or without FNA performed, and to investigate possible predictive factors for thyroid malignancy in a population with recent moderately low iodine intake. METHODS All patients referred for thyroid surgery in a tertiary cancer centre between 2000 and 2016 were included (n = 3,703). After excluding cases indicating malignant histology, we included group 1: patients with benign FNA (n = 764), and group 2: patients without FNA (n = 740), leaving 1,504 eligible for further investigation. Information on age, gender, tracheal compression or dislocation, thyroid specimen weight, scintigraphy, ultrasound, medically treated thyrotoxicosis, serum stimulating thyroid hormone, indication for surgery, TNM classification, stage, and outcome were retrieved. RESULTS The malignancy risk was 7.6% (58/764) in group 1 and 6.8% (50/740) in group 2. Patients with T2-4 tumours constituted 2.2% (33/1,504). In the combined groups, ultrasound verified that solitary solid tumour was predictive for malignancy (p = 0.01 by χ2, and OR = 1.69, p = 0.02 in multiple logistic regression). For group 1 patients, thyrotoxicosis (which in this case was medically treated) was a significant predictive factor for malignancy (p = 0.04). CONCLUSIONS The risk of malignancy of 7.6% and 6.8% was high, considering that patients with malignant FNA, suspicious FNA, or clinical findings indicating malignancy were excluded, and 2.2% of these malignancies were stages T2-4. In cases with solitary solid tumour on ultrasound, the risk of malignancy should not be ignored, even with benign FNA.
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Affiliation(s)
- Signe Buhl Gram
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
- *Signe Buhl Gram, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, F2073, Blegdamsvej 9, DK–Copenhagen 2100 (Denmark), E-Mail
| | - Jacob Høygaard Rasmussen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Jens Bentzen
- Department of Oncology, Herlev Hospital, Copenhagen University, Copenhagen, Denmark
| | - Giedrius Lelkaitis
- Department of Pathology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Christoffer Holst Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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10
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You E, Mascarella MA, Al Jassim A, Forest VI, Hier MP, Tamilia M, Pusztaszeri M, Payne RJ. Prevalence and aggressiveness of papillary thyroid carcinoma in surgically-treated graves' disease patients: a retrospective matched cohort study. J Otolaryngol Head Neck Surg 2019; 48:40. [PMID: 31462328 PMCID: PMC6714443 DOI: 10.1186/s40463-019-0364-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Reported rates of thyroid cancer in Graves’ disease (GD) vary widely. The aim of this study was to evaluate the prevalence of papillary thyroid carcinoma (PTC), including aggressive forms, in GD compared to matched controls undergoing thyroidectomy. Furthermore, it seeks to elucidate any patient- or tumour-associated factors predictive of malignancy or an aggressive course. Methods We performed a matched cohort study of GD patients undergoing thyroidectomy at our institution between 2006 to 2018. Clinicodemographic factors, preoperative characteristics, surgical factors, final histopathology as well postoperative course were collected. Aggressive PTC was defined as evidence of lymph node metastasis, extrathyroidal extension, gross vascular invasion and/or aggressive histologic variants. Prevalence of PTC was compared with sex, age and nodule size-matched euthyroid patients that underwent thyroidectomy in the same time period. Results A total of 132 patients were included in the study with a mean age of 46 (±14) years. Malignancy was identified in 36/66 (55%) patients with GD; 20/66 (30%) were incidental carcinomas and 9/66 (14%) were associated with aggressive pathologic features. In the aggressive group, lymph node metastasis to the central compartment was present in 8 (12%) cases, extrathyroidal extension in 4 (6%) cases and one (1.5%) patient had a diffuse sclerosing tumor variant. No significant differences in outcome were found between the two groups. GD patients were more likely to have incidental carcinomas (p = 0.035). Adjusting for baseline patient characteristics, GD patients demonstrated an increased likelihood of harbouring a malignancy (odds ratio (OR) = 2.67; 95% confidence interval (CI) 1.00–7.18) compared to controls. Conclusion More than half of patients with GD undergoing thyroidectomy had concurrent thyroid malignancy with aggressive features present in 14% of patients. GD may confer a heightened risk of thyroid cancer; thyroid nodules should therefore be carefully investigated.
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Affiliation(s)
- Eunice You
- McGill University, Montreal, Quebec, Canada
| | - Marco A Mascarella
- McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,McGill Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Quebec, Canada
| | - Abrar Al Jassim
- McGill University, Montreal, Quebec, Canada.,Western Otolaryngology - Head and Neck Surgery, London, Ontario, Canada
| | - Veronique-Isabelle Forest
- McGill University, Montreal, Quebec, Canada.,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael P Hier
- McGill University, Montreal, Quebec, Canada.,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael Tamilia
- McGill University, Montreal, Quebec, Canada.,Division of Endocrinology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marc Pusztaszeri
- McGill University, Montreal, Quebec, Canada.,Department of Pathology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Richard J Payne
- McGill University, Montreal, Quebec, Canada. .,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
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11
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Yabanoğlu H, Arer İM, Koçer NE, Sakulen Hargura A, Avcı T. Graves hastalığında tiroid kanser sıklığının değerlendirilmesi. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.512517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Evranos B, Polat SB, Cuhaci FN, Baser H, Topaloglu O, Kilicarslan A, Kilic M, Ersoy R, Cakir B. A cancer of undetermined significance: Incidental thyroid carcinoma. Diagn Cytopathol 2018; 47:412-416. [PMID: 30488670 DOI: 10.1002/dc.24117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The incidence of thyroid cancer is increasing which can be attributed in part to improved ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC). We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study. METHODS Retrospective analyses of 906 individual patients who were operated for benign and malignant thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in US or FNA results were classified as NITC. RESULTS Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age was 51.7 ± 11.11 in ITC group and 48.15 ± 13.1 in NITC group (P < .001). In NITC group 322 (55.5%) of the patients were operated for suspicious cytology while only 29 (8.9%) of the patients in the ITC group were operated because of this indication (P < .001). There were 1301 cancer foci in histopathology specimens. Among all these cancer foci, 434 (33.3%) were detected incidentally and 867 (66.7%) were detected non-incidentally. About 779 (89.9%) of nonincidental cancer foci were papillary cancer (PTC), while all of the incidental cancer foci were PTC. Mean size was 13 mm in NITC group and it was 3 mm in the ITC group and differed significantly between the groups (P < .001). Tumor size was ≤1 cm in 35.2% of the patients with NITC while 98.5% of patients with ITC had tumor ≤1 cm. The occurrence of multinodularity was higher in ITC than the NITC group (P < 001). Median TSH level was higher in patients with NITC than ITC while both were in the reference range (1.53 vs 1.03 μIU/mL, P < .001). The frequency of thyroiditis detected by US, and thyroid peroxidase antibody and thyroglobulin antibody positivities were similar in patients with ITC and NITC (P = .2, P = .86, and P = .26, respectively). The frequencies of capsular invasion (29.1% vs 7.9%), extrathyroidal extension (13% vs 4.2%), multifocality (35.8% vs 24.2%), non-complete resection (9.2% vs 1.8%), and lymph node metastasis (9.5% vs 1.8%) were significantly higher in the NITC group (P < .001, for each). Persistent/recurrent disease in patients with NITC was more frequent than patients with ITC (P = .004). This outcome was similar for cancers measuring ≤1 cm (P = .001). CONCLUSION ITC is often encountered in older patients and frequently determined in early stages with more favorable histopathological features and better prognosis.
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Affiliation(s)
- Berna Evranos
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Sefika Burcak Polat
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Fatma Neslihan Cuhaci
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Husniye Baser
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Oya Topaloglu
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Aydan Kilicarslan
- Department of Pathology, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Kilic
- Department of General Surgery, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
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13
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Gül N, Üzüm AK, Selçukbiricik ÖS, Yegen G, Tanakol R, Aral F. Prevalence of papillary thyroid cancer in subacute thyroiditis patients may be higher than it is presumed: retrospective analysis of 137 patients. Radiol Oncol 2018; 52:257-262. [PMID: 30210035 PMCID: PMC6137358 DOI: 10.2478/raon-2018-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/12/2018] [Indexed: 01/03/2023] Open
Abstract
Background The association of subacute thyroiditis (SAT) and papillary thyroid carcinoma is a rare finding. In this study, we aimed to investigate the prevalence of differentiated thyroid cancer in a cohort of patients followed with the diagnosis of SAT. Patients and methods We retrospectively screened medical records of Endocrinology and Metabolism outpatient clinic in the past 20 years for patients with SAT. Patients with nodules and suspicious ultrasonography findings who underwent fine needle aspiration biopsy (FNAB) and operated due to malignancy risk were identified. Results We identified 137 (100 females, 37 males) patients with reliable records to confirm the diagnosis of SAT. The mean age of female patients was 41.1 ± 9.1 (range, 20-64) and of male patients was 43.0 ± 9.3 (range, 20-65). One or more FNAB was performed in 23 of the patients (16.8%) at the beginning and/or during the follow-up period when needed. Seven patients with suspicious FNAB findings were operated, and histopathological examination of the nodules confirmed the diagnosis of papillary thyroid carcinoma in 6 patients (4.4%). Conclusions Our observations suggesting a relatively higher prevalence of thyroid cancer in a small series of SAT patients warrant further studies to identify the real frequency of differentiated thyroid cancer and its association with inflammatory pathogenesis of SAT. This finding is compatible with the trend of increased thyroid cancer incidence all over the world. A repeat ultrasonography after resolution of clinical and inflammatory findings, and FNAB should be recommended to all patients with suspicious nodules.
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Affiliation(s)
- Nurdan Gül
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşe Kubat Üzüm
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Özlem Soyluk Selçukbiricik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gülçin Yegen
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Refik Tanakol
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ferihan Aral
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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14
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Coexistent thyroid nodules in patients with graves' disease: What is the frequency and the risk of malignancy? Am J Surg 2018; 216:980-984. [PMID: 30049435 DOI: 10.1016/j.amjsurg.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/12/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to determine the frequency of coexistent thyroid nodules and the rate of malignancy in patients with surgically treated Graves' disease (GD). METHODS A retrospective review of all patients with GD who underwent thyroidectomy from 1990 to 2017 was completed. Pathology reports were reviewed for coexistent nodules. Demographics, nodule size, and results of ultrasound, 123I scintigraphy, fine needle aspiration biopsy and pathology were analyzed. RESULTS There were 233 patients with GD who underwent thyroidectomy, 103 (44%) had one or more thyroid nodules, which were incidentally discovered on pathologic exam in 54(52%) patients. 14 (6%) patients had cancer, 9 (4%) papillary microcarcinoma and 5 (2%) papillary cancer ≥ 1 cm that occurred within a nodule diagnosed preoperatively. CONCLUSIONS Most thyroid nodules in patients with GD were incidentally discovered on pathologic exam. A higher rate of malignancy was found in patients with GD and clinically identifiable nodular disease.
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15
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Krátký J, Ježková J, Kosák M, Vítková H, Bartáková J, Mráz M, Lukáš J, Límanová Z, Jiskra J. Positive Antithyroid Antibodies and Nonsuppressed TSH Are Associated with Thyroid Cancer: A Retrospective Cross-Sectional Study. Int J Endocrinol 2018; 2018:9793850. [PMID: 30258461 PMCID: PMC6146563 DOI: 10.1155/2018/9793850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
The relationship between Hashimoto's thyroiditis (HT) and thyroid cancer (TC) is a controversial topic; it remains unclear if HT acts as a risk factor of TC. The aim of our study was to compare the presence of HT and thyroid function in patients with TC and benign nodules. We analyzed 2571 patients after fine needle aspiration biopsy of thyroid nodule. Totally, 91 patients with primary TC and 182 sex- and age-matched controls were included. Positive antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg) antibodies were associated with TC (anti-TPO 44% in TC vs. 27% in controls, P = 0.005, anti-TG 35% in TC group vs. 21% in controls, P = 0.018), and the TC group had significantly higher TSH (median 1.88 mIU/l vs. 1.21 mIU/l, P < 0.001). Using multiple logistic regression, positive anti-TPO was identified as an independent risk factor (OR 2.21, P = 0.018), while spontaneously suppressed TSH < 0.5 mIU/l was a protective factor (OR 0.3, P = 0.01) against TC. In conclusion, nodules in subjects with positive antithyroid antibodies could be considered to have a higher risk of malignancy. However, based on our results, it is not possible to declare that TC is triggered by HT.
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Affiliation(s)
- Jan Krátký
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 1, 128 08 Praha 2, Czech Republic
| | - Jana Ježková
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 1, 128 08 Praha 2, Czech Republic
| | - Mikuláš Kosák
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 1, 128 08 Praha 2, Czech Republic
| | - Hana Vítková
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 1, 128 08 Praha 2, Czech Republic
| | - Jana Bartáková
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 1, 128 08 Praha 2, Czech Republic
| | - Miloš Mráz
- Dialectology Center, Institute of Clinical and Experimental Medicine, Vídeňská 1958, 140 21 Praha 4, Czech Republic
| | - Jindřich Lukáš
- Department of ENT, Surgery of Head and Neck, Na Homolce Hospital, Roentgenova 2/37, 150 00 Praha 5, Czech Republic
| | - Zdenka Límanová
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 1, 128 08 Praha 2, Czech Republic
| | - Jan Jiskra
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 1, 128 08 Praha 2, Czech Republic
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16
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Aoyama M, Takizawa H, Tsuboi M, Nakagawa Y, Tangoku A. A case of metastatic follicular thyroid carcinoma complicated with Graves' disease after total thyroidectomy. Endocr J 2017; 64:1143-1147. [PMID: 28883260 DOI: 10.1507/endocrj.ej17-0220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thyroid cancer and Graves' disease may present simultaneously in one patient. The incidence of the development of hyperthyroidism from metastatic differentiated thyroid carcinoma is rare. We herein report a case of metastatic follicular carcinoma complicated with Graves' disease after total thyroidectomy. A 57-year-old woman underwent right hemithyroidectomy for follicular carcinoma. Metastatic lesions appeared in the lungs and skull two years after the first surgery, and remnant thyroidectomy was performed for radioactive iodine-131 (RAI) therapy, during which the TSH receptor antibody (TRAb) was found to be negative. The patient was treated with RAI therapy four times for four years and was receiving levothyroxine suppressive therapy. Although radioiodine uptake was observed in the lesions after the fourth course of RAI therapy, metastatic lesions had progressed. Four years after the second surgery, she had heart palpitations and tremors. Laboratory data revealed hyperthyroidism and positive TRAb. She was diagnosed with Graves' disease and received a fifth course of RAI therapy. 131I scintigraphy after RAI therapy showed strong radioiodine uptake in the metastatic lesions. As a result, the sizes and numbers of metastatic lesions decreased, and thyroid function improved. Metastatic lesions produced thyroid hormone and caused hyperthyroidism. RAI therapy was effective for Graves' disease and thyroid carcinoma.
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Affiliation(s)
- Mariko Aoyama
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima 770-8509, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima 770-8509, Japan
| | - Mitsuhiro Tsuboi
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima 770-8509, Japan
| | - Yasushi Nakagawa
- Department of surgery, Tokushima Prefectural Central Hospital, Tokushima 770-8539, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health, Biosciences, The University of Tokushima, Tokushima 770-8509, Japan
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17
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Hussain YS, Hookham JC, Allahabadia A, Balasubramanian SP. Epidemiology, management and outcomes of Graves' disease-real life data. Endocrine 2017; 56:568-578. [PMID: 28478488 PMCID: PMC5435772 DOI: 10.1007/s12020-017-1306-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/17/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE Treatment options in Graves' disease are clearly defined, but management practices and the perceptions of success are varied. The outcomes of treatment in large consecutive cohorts of Graves' disease have not been well characterised. The study describes the epidemiology, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in Graves' disease. METHODS All patients (n = 659) who received treatment for a new diagnosis of Graves' disease in secondary care over a 5 year period were included with a median (interquartile range) follow-up of 42.9 (29-57.5) months. RESULTS The age adjusted incidence of adult onset Graves' disease in Sheffield, UK was 24.8 per 100,000 per year. Excluding 35 patients lost to follow-up, 93.1% (n = 581) were controlled on anti-thyroid drug treatment. Of these, 73.6% went into remission following withdrawal of anti-thyroid drugs; 5.2% were still undergoing initial therapy; 13.3% lost control whilst on anti-thyroid drugs; and 7.9% went on to have either surgery or radio-iodine ablation whilst controlled on anti-thyroid drugs. Of the 428 patients who achieved remission, 36.7% relapsed. Of 144 patients who had radio-iodine ablation treatment, 5.6% relapsed and needed further treatment. Of 119 patients having surgery, 5.2% had long-term hypoparathyroidism and none had documented long-term recurrent laryngeal nerve palsy. CONCLUSIONS In the follow-up, 39.9% of patients underwent surgery or radio-iodine ablation with little morbidity. Up to two-thirds of patients who achieved remission did not relapse. Data on effectiveness and risks of treatments for Graves' disease presented in this study will help clinicians and patients in decision making.
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Affiliation(s)
- Y S Hussain
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J C Hookham
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Allahabadia
- Directorate of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
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18
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Louvet C, De Bellis A, Pereira B, Bournaud C, Kelly A, Maqdasy S, Roche B, Desbiez F, Borson-Chazot F, Tauveron I, Batisse-Lignier M. Time course of Graves' orbitopathy after total thyroidectomy and radioiodine therapy for thyroid cancer. Medicine (Baltimore) 2016; 95:e5474. [PMID: 27902601 PMCID: PMC5134772 DOI: 10.1097/md.0000000000005474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The risk of cancer is relatively higher in Graves' patients presenting simultaneously with thyroid nodules. Radioiodine (RAI) therapy recommended in high-risk differentiated thyroid carcinoma may be associated with worsening of a pre-existing Graves' orbitopathy (GO) or developing a new onset. The impact of RAI therapy in patients with differentiated thyroid cancer on the course of a pre-exisiting GO has not been specifically investigated.The aim of this study is to assess the influence of RAI treatment administered for differentiated thyroid cancer on the course of a pre-existing GO.This is a retrospective multicenter study including 35 patients from the University Hospital of Clermont-Ferrand (7 patients) and Lyon-Est (6 patients) in France and from a literature review published as case reports or studies (22 patients).Seven patients exhibited a worsened pre-existing GO after total thyroidectomy followed by RAI treatment for thyroid cancer. Older men, those who initially presented with a lower clinical score of GO before RAI therapy, received higher doses of I especially when prepared with recombinant thyroid-stimulating hormone, and/or not prepared with glucocorticoids during RAI are at a higher risk to worsen their GO.This study is the first and complete study collection. We describe worsening of GO in 20% of patients after RAI treatment for thyroid cancer and determine a pool of predictive factors.
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Affiliation(s)
- Camille Louvet
- CHU Clermont-Ferrand, Endocrinology Department, Clermont-Ferrand, France
| | - Annamaria De Bellis
- Department of Clinical and Experimental Medicine and Surgery “F. Magrassi, A. Lanzara,” Second University of Naples, Naples, Italy
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Direction), Clermont-Ferrand
| | - Claire Bournaud
- Department of nuclear medicine, Hospices civils de Lyon, Groupement hospitalier Est, Bron, France
| | - Antony Kelly
- Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand
| | - Salwan Maqdasy
- CHU Clermont-Ferrand, Endocrinology Department, Clermont-Ferrand, France
- UMR CNRS 6293, INSERM U1103, Génétique Reproduction et Développement, Université Clermont-Auvergne, Aubiere
| | - Beatrice Roche
- CHU Clermont-Ferrand, Endocrinology Department, Clermont-Ferrand, France
| | - Francoise Desbiez
- CHU Clermont-Ferrand, Endocrinology Department, Clermont-Ferrand, France
| | - Francoise Borson-Chazot
- Department of Endocrinology, Hospices Civils de Lyon, Bron, Université Lyon I
- Lyon 1 University, CRCL, INSERM U1052, Lyon, France
| | - Igor Tauveron
- CHU Clermont-Ferrand, Endocrinology Department, Clermont-Ferrand, France
- UMR CNRS 6293, INSERM U1103, Génétique Reproduction et Développement, Université Clermont-Auvergne, Aubiere
| | - Marie Batisse-Lignier
- CHU Clermont-Ferrand, Endocrinology Department, Clermont-Ferrand, France
- UMR CNRS 6293, INSERM U1103, Génétique Reproduction et Développement, Université Clermont-Auvergne, Aubiere
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A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule. Case Rep Surg 2016; 2016:8740405. [PMID: 27110424 PMCID: PMC4826690 DOI: 10.1155/2016/8740405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/13/2016] [Indexed: 12/03/2022] Open
Abstract
Objective. Marine-Lenhart Syndrome (MLS) is defined as concomitant occurrence of autonomously functioning thyroid nodule (AFTN) with Graves' disease (GD). Malignancy in a functional nodule is rare. We aimed to present an extremely rare case of papillary thyroid cancer in a MLS nodule with lateral lymph node metastases. Case. A 43-year-old male presented with hyperthyroidism and Graves' ophthalmopathy. On Tc99m pertechnetate scintigraphy, a hyperactive nodule in the left upper thyroid pole was detected and the remaining tissue showed a mildly increased uptake. The ultrasonography demonstrated 15.5 × 13.5 × 12 mm sized hypoechoic nodule in the left upper pole of the thyroid and round lymph nodes on the left side of the neck. Fine needle aspiration biopsy (FNAB) of the nodule and lymph node revealed cytological findings consistent with papillary cancer. Total thyroidectomy with central and left modified radical neck dissection was performed. On pathologic examination, two foci of micropapillary cancer were detected. The skip metastases were present in three lymph nodes on the neck. Conclusion. AFTN can be seen rarely in association with GD. It is not possible to exclude malignancy due to the clinical and imaging findings. In the presence of suspicious clinical and sonographic features, FNAB should be performed.
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